Assisted Peritoneial Dialysis - Opportunity For Equal Access To Renal Replacement Therapy By Peritoneal Dialysis

Abstract

Advances in science and dialysis technology have allowed patients with end-stage renal disease (ESRD) to continue living by starting renal replacement therapy (RRT) - peritoneal dialysis (PD), hemodialysis (HD) or renal transplantation – “a gifted life”. It is recommended that the initial RRT be PD, and later switch to HD if no renal transplantation has been performed yet. In recent years, there has been an increase of elderly patients with a physical or intellectual inability to perform PD alone - they either begin HD or (all too often) sign an informed disagreement on RRT. Assisted PD (aPD) is appropriate for these patients. Assisted PD is also indicated in patients on PD who have developed complications/illnesses that make them unable to cope on their own. Do all patients have an equal chance of starting assisted PD? In Bulgaria, assisted PD is not regulated as a medico-social activity, but there are patients who need assistance. Usually that is done by trained family members. There are patients, however, who cannot rely on the help of relatives, and those in hospices and nursing homes who do not have the chance to benefit from the assisted PD. In many European countries, there is a medico-social network providing assisted PD. The regulation of assisted PD in Bulgaria as a type of medico-social activity done by trained staff in patients' homes, hospices and nursing homes would allow every patient to have equal access to assisted PD and an equal chance for a better quality of life.